Two roads diverge on health reform

Two roads lie ahead when it comes to health reform and the newly-elected president.

One is characterized by caution. Don't try to do too much too fast, its proponents argue. Start with what's achievable, given the poor state of the economy, and build from there, working systematically to lower costs and expand coverage over time, they argue.

The other is characterized by sweeping ambition. Incremental reform won't make any difference except at the margins: something much bigger, something really transformative is needed, its supporters insist.

In the first camp are those who want to expand the State Children's Health Insurance Program when Congress reconvenes next year and include extra Medicaid funding for the states in an economic stimulus package.

Today, I heard from another group that falls in this category: a coalition of 75 advocacy groups that plans to press Congress to end the two year waiting period imposed on people with disabilities who apply for Medicare coverage.

In the second camp falls a coalition known as Divided We Fail which today launched a campaign to convince President-elect Barack Obama o make comprehensive health reform a priority.

Divided We Fail includes AARP, Services Employees International Union, the Business Business Roundtable and the National Federal of Independent Businesses, organizations that a decade ago didn't agree on much when it came to this topic.

The Los Angles Times reports that the group sent a letter to Obama this week urging him to act decisively in his first 100 days in office.

"Addressing skyrocketing healthcare costs is a critical component of stabilizing household, national and global economies," according to the letter, quoted in the Times. "Inaction undermines the economic security of our families; limits the productivity of our workforce; stagnates job creation and wage growth; and threatens to crowd out investments in energy, education and infrastructure."

The Times also reports that SEIU is mobilizing millions of members. "We are going to run this like it is a presidential campaign, but our candidate will be healthcare reform," Dennis Rivera, chairman of SEIU Healthcare, told the newspaper.

In the background is this thought: the time for a massive change in health care is now, while Obama is riding the extraordinary reaction to his extraordinary victory, before partisan bickering begins afresh and interest groups come up with 1,001 reasons to keep the status quo intact.

In the background of the first camp are these thoughts: if you're going to overhaul the health care system, you better do it right because the cost of getting it wrong is unimaginably high and will burden the country for years to come. The safer course is to take it a step at a time and see what works, rather than risk failure.

What would you advise the incoming president and what's the rationale for your recommendation?

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